The $30bn question

The IDEA 'razor' has served us well, a simple question that both illustrates a mindset and illuminates our methods: if you gave the same drug to two different companies at the start of phase I, would they be equally successful?

You suspect the answer is 'no' and you'd be with every other person in our industry. Yet, the industry behaves as if the answer is 'yes', and that getting the 'right' drug to the start of clinical development is the greatest challenge.

It might seem like a hypothetical. But it runs as an active real life experiment constantly. Perhaps the most stark is the immuno-oncology landscape, a landscape of ideas, at least as much as of molecules. When everyone has one, what you do with it becomes the most important thing. (Interesting stat: if you subtract R&D spend from these revenues, Opdivo still comes out ahead, which seems counter-intuitive, given Keytruda's dominance of the 'good news' stories...)

There could be a long conversation about whether any of these molecules is truly 'better' than the others (and at what, one might ask...?), but let's accept that before 2010 most 'oncology' companies had views about the merits of PD-1 and PD-L1. Because of who they were, what they needed, what they 'knew', what they were protecting and how they took decisions, we got to watch our question play out. If companies didn't have a PD-1 or PD-L1 in development, they certainly could have. It's an idea, at least as much as it is a particular molecule...

The great thing about the question: it focuses on the creation of value, not on the cleverness of the idea - on innovation, not invention. The companies who do better are those who emphasise learning rather than knowing, and given that they know they are in a race, learning better, faster and more honestly than the competition.

Many would prefer to focus on reasons that this market looks the way it does: indications, positive studies, timing, marketing. But each of those is a choice, a decision, not something intrinsic to the molecule. The $30bn opportunity here was here for every company in this market, given different decisions back in the 2000s.

You can't forecast molecules, you can only forecast molecules and decisions. So, you'd think, with $30bn sitting in the 'learning and decision-making' pot that it would be companies' main focus, and that we'd stop doing things we can't do in early phase, and start doing things we can. That's not what we see. We see leaders who get this, and a majority who don't. It is good news for our case studies, as we will get charts like this for a long time to come. But it is an odd choice to make - to ignore the opportunity. It may well be true that it is hard to leave behind a system that is working to jump to a different one. But if it isn't working...?

Even if you don't want to change everything, you could:

• give the same drug to two teams within your company, and see how they differ (after all, one is bound to make different decisions than the other)
• let a franchise operate independently of the main decision process
• give the same drug to a skunkworks team and an internal team

The future is a consequence of decisions - making better decisions than your competition should be your competitive advantage.